Overview - Bringing About Changes in Clinical Practice
Future of Family Medicine Report Overview
The New Model of care recommended by the Future of Family Medicine Project is based on the concept of a personal medical home that will reintegrate the patient, the physician and the practice. The personal medical home will serve as a focal point through which all individuals - regardless of age, sex, race or socioeconomic status - receive a consistent basket of acute, chronic and preventive medical care services.
Patient focus
The cornerstone of the New Model medical office is patient-centered care based on a personal patient-physician relationship that is highly satisfying to both the patient and the physician. In the New Model, the patient, not the physician, will occupy center stage. From first contact through the completion of the care episode, the patient will meet with consistent and competent caring that is culturally and linguistically appropriate. The New Model will strive to meet patient and community needs for integrated care by giving patients what they want and need, when they want and need it, by anticipating patient needs and designing services to meet those needs.
Access to care
Accepting the complexity of health and health care, the New Model medical office will provide multiple ways for patients to access care. Although the office setting will continue to be an important site for care, future family physicians will be prepared to provide services in a variety of settings, including hospitals, long-term care facilities and community health centers; in short, they will provide care wherever the family physician's services are needed.
Team approach to care
Patient care in the New Model will be provided through a multidisciplinary team approach and grounded in a thorough understanding of the population served by the medical office. In addition to nurses and clerical personnel, staffing will often include nutritionists, health educators, behavioral scientists, physician's assistants and nurse practitioners, as well as other professional and lay partners. A cooperative effort among all clinicians will be the cultural norm.
Basket of services
The New Model medical office will provide the full basket of clinical services offered by family medicine, either directly through its own clinicians or indirectly through established, ongoing relationships with experienced clinicians outside of the office. The basket of services that patients can be assured of receiving through the New Model will include the management of acute injuries and illnesses, chronic diseases, health promotion and disease prevention, well child care, child development and anticipatory guidance services and supportive care.
Electronic health record
A standardized electronic health record, adapted to the specific needs of family physicians, will constitute the central nervous system of the New Model medical office. The information systems of the New Model will facilitate the integration of the care of the whole person in the context of family and community. The systems will include evidence-based clinical practice guidelines for enhancing the care of individual conditions most commonly encountered by family physicians. They will have an order entry and referral tracking system, a managed care organization-specific pharmacy formulary and Web-enabled access to data repositories, with appropriate levels of security. The systems also will generate chronic disease registries to ensure that patients can be contacted for care at appropriate time intervals, track health maintenance interventions, and generate physician and patient reminders for personalized preventive services.
Open scheduling and communication
Practices will use an open scheduling model for patient visits, while offering flexible and expanded office hours. Interactions will not be limited to traditional, individual, face-to-face encounters between the patient and the family physician. Where feasible and as systems evolve, New Model practices will develop a Web portal and will use secure e-mail to provide convenient options for communication between patients and office staff. Patients will be able to make appointments online through the office Web site and access online patient education materials appropriate to their health status.
Redesigned offices
As part of the New Model, offices will be convenient, attractive and functional, with private, comfortable space to accommodate group visits with selected patients who share common health concerns. The new office model will incorporate concepts from industrial engineering and customer service, and integrate those needs and concepts into a coherent and comprehensive approach to care. The traditional waiting room will be a thing of the past, replaced by a patient resource center with a patient library, computer work stations with ready access to online health education materials and patient information-gathering stations.
Focus on quality and safety
The New Model medical office will also seek to continuously improve the quality of patient care. Family physician offices will document quality and safety through ongoing analyses of patient care data. The New Model will place a high priority on taking steps to ensure patient safety within the practice, including use of electronic data and decision support systems. Patient feedback will be solicited to ensure that the practice is meeting patients' expectations, satisfying their needs for access to the practice, and responding to the needs of increasingly diverse populations.
Enhanced practice finance
Improved operating efficiencies will decrease expenses and contribute to improved practice margins. The New Model practice anticipates additional revenues to cover its costs and reward high performance. The New Model will be organized to accommodate all payment options while advocating for health insurance coverage of all Americans.